Provider-related barriers to accessing emergency contraception in developing countries: A literature review

Abstract

This report benefitted from the contributions of numerous individuals and institutions. Firstly, I would like to acknowledge the authors of the documents included in this review, as this research would not have been possible without their well-conducted, and documented, program and research activities. I also would like to thank my colleague Martha Brady for her in-depth and substantive contributions to, and conceptualization of, the available evidence with particular regard to repeat use of emergency contraception. I would like to acknowledge the contributions of other colleagues at Population Council, including Saumya RamaRao, Ian Askew, and John Townsend, for their guidance offered during this review's development and finalization. I am also appreciative of support provided by Elizabeth Westley of Family Care International who has helped frame this work in the larger context and contributed research, perspective, and data for consideration. Finally, I gratefully acknowledge the support from the International Consortium for Emergency Contraception for this literature review and larger project, "Provider Beliefs, Attitudes and Practices Concerning Emergency Contraception." With concurrent activities at ICEC, FHI, Gynuity, and Population Council, this literature review intends to contribute to a global strategy for improving access to emergency contraception, and I am grateful for this opportunity to contribute to such a worthwhile aim.

Keeping silent about emergency contraceptives in Addis Ababa: a qualitative study among young people, service providers, and key stakeholders

“…The results also coincide with other countries where studies similarly found moral attitudes among key stake holders and service providers, and showed that ECs fit into young people’s lives [2-4,18]. Due to the sensitivity of the topic, it is possible that some young people, especially those whom we approached in the pharmacies (where there was little opportunity for rapport building), underreported the number of times they had used ECs.…”

“…They expressed worries related to negative effects on women’s health, promiscuity, and a fear that young people will forget about condoms in favour of using ECs. Similar concerns have been found among providers in other African and Asian countries, including negative opinions about repeat use, such as the belief that ECs are not meant to be used regularly and can be risky for women’s health [18]. Informally, many service providers in our study mentioned that they only continue to sell the Postpill to young people out of fear of losing clients and thus business.…”

Medical barriers to emergency contraception: a cross-sectional survey of doctors in North India

“…Doctors' biases reported in earlier literature were confirmed by this study 18 . A majority of doctors oppose ECPs as a prophylactic and as an OTC drug.…”

“…Often those opposing OTC sales lack knowledge about the mechanism of action and have a misunderstanding that ECPs induce abortion, or they fear that ECPs may be used for regular contraception and misused by adolescents 16 – 20 . Parents also fear that wide availability of ECPs will increase promiscuous, premarital, and irresponsible sex as well as increase the risk of acquiring sexually transmitted infections (STIs) 18 – 22 …”

Providers' and key opinion leaders' attitudes, beliefs, and practices regarding emergency contraception in Nigeria

“…Stakeholders' support will, to a large extent, determine supply and demand, legality and regulation, awareness of and support for, and public facility distribution, or lack thereof, of EC (Williams 2011). In some countries, EC availability and accessibility have stalled due to groups opposed to FP generally and those who perceive EC as abortifacient.…”